Use of a tissue clearing technique combined with retrograde trans-synaptic viral tracing to evaluate changes in mouse retinorecipient brain regions following optic nerve crush.

Successful establishment of reconnection between retinal ganglion cells and retinorecipient regions in the brain is critical to optic nerve regeneration. However, morphological assessments of retinorecipient regions are limited by the opacity of brain tissue. In this study, we used an innovative tissue cleaning technique combined with retrograde trans-synaptic viral tracing to observe changes in retinorecipient regions connected to retinal ganglion cells in mice after optic nerve injury. Specifically, we performed light-sheet imaging of whole brain tissue after a clearing process. We found that pseudorabies virus 724 (PRV724) mostly infected retinal ganglion cells, and that we could use it to retrogradely trace the retinorecipient regions in whole tissue-cleared brains. Unexpectedly, PRV724-traced neurons were more widely distributed compared with data from previous studies. We found that optic nerve injury could selectively modify projections from retinal ganglion cells in the hypothalamic paraventricular nucleus, intergeniculate leaflet, ventral lateral geniculate nucleus, central amygdala, basolateral amygdala, Edinger-Westphal nucleus, and oculomotor nucleus, but not the superior vestibular nucleus, red nucleus, locus coeruleus, gigantocellular reticular nucleus, or facial nerve nucleus. Our findings demonstrate that the tissue clearing technique, combined with retrograde trans-synaptic viral tracing, can be used to objectively and comprehensively evaluate changes in mouse retinorecipient regions that receive projections from retinal ganglion cells after optic nerve injury. Thus, our approach may be useful for future estimations of optic nerve injury and regeneration.

Evaluation of dynamic stereopsis in intermittent exotropia patients.

AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in this study. The normal and X(T) groups were used to test the reproducibility and reliability of the dynamic stereopsis test, and Bangerter filters with densities of 0.2 were then used to simulate suppression to test for traditional and dynamic stereopsis. In the X(T) group, the measurements included 1) dynamic stereopsis test comprising three parts: motion+disparity, motion only and disparity only; 2) ocular deviation angle; 3) Bagolini striated lens test; 4) disease course; and 5) Titmus stereopsis test. RESULTS: The test-retest reliability of the dynamic stereopsis method was 0.901 in the normal and X(T) groups, and none of the X(T) patients were able to pass the static and dynamic stereopsis tests after using the 0.2 Bangerter filter. The accuracy rate was greater than 80% in the normal group and 31.81%, 36.36%, and 45.45% for the motion+disparity, motion-only and disparity-only components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests, respectively. Patients with a long disease course (>1y) had worse dynamic stereopsis than those with a short disease course (<1y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparity-only, or the motion-only test components (all P>0.05, Chi-square test). CONCLUSION: Dynamic stereopsis is preserved in certain X(T) patients diagnosed with stereoblindness via traditional tests. A long disease course was shown to be a negative factor for dynamic stereopsis in X(T) patients which might be associated with worse progression, and provide good references clinically.

Efficacy of autologous conjunctival flap on repairing the late-onset filtering bleb leakage.

AIM: To evaluate the effectiveness of autologous conjunctival flap surgery for repairing the late-onset filtering bleb leakage after trabeculectomy. METHODS: This study retrospectively reviewed 106 eyes from 106 patients with late-onset filtering bleb leakage after trabeculectomy who received autologous conjunctival flap surgery at the Zhongshan Ophthalmic Centre from 2005 to 2015. The basic information was recorded, and the interval time between trabeculectomy and autologous conjunctival flap surgery as well as related risk factors, intraocular pressure (IOP), anterior chamber depth (ACD) and best corrected visual acuity (BCVA) were analysed. Moreover, 41 patients who completed the 1-year follow up were analysed to determine the IOP and BCVA changes and long-term success rates. RESULTS: The 50 male and 56 female subjects (average age 39.13±17.96y) included 47 (44.34%) and 33 (31.13%) cases of primary open angle and primary angle-closure glaucoma. The mean interval between trabeculectomy and repair surgery was 60.60±56.92 (3-264)mo. The mean mitomycin (MMC) concentration during trabeculectomy was 0.27±0.04 (0.12-0.4) mg/mL in the fornix-based conjunctival flap group (68 patients) and 0.28±0.04 (0.20-0.33) mg/mL in the limbal-based conjunctival flap group (11 patients). After bleb leakage, the patients' vision remained stable while the IOP decreased from 10.25±4.76 (3-20.86) to 9.44±4.33 (2-21) mm Hg (P<0.01). In the 41 analysed patients, the IOP was controlled at 15.68±5.11 (7-40) mm Hg in the 1st year after autologous conjunctival flap surgery and recurrence was not observed, for a long-term success rate of 100%. CONCLUSION: Autologous conjunctival flap repairing surgery is an effective technique for sealing filtering bleb leakages and controlling IOP postoperatively.

Longitudinal Cohort Study on the Incidence of Primary Open-Angle Glaucoma in Bai Chinese.

PURPOSE: The prevalence of primary open-angle glaucoma (POAG) in China has been reported previously, and was lower than that in white and black populations. However, the incidence of POAG in China has not been reported. Therefore, a longitudinal study was conducted to determine the 5-year cumulative incidence and predictors of POAG in China. DESIGN: Population-based cohort study. METHODS: A total of 1520 participants (71.3% of the subjects in the baseline survey) of Bai ethnicity were examined and followed for 5 years. Glaucoma was defined based on the International Society of Geographical and Epidemiological Ophthalmology Classification criteria. Multivariable logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS: A total of 19 new cases of POAG were detected. The 5-year cumulative incidence of POAG was 1.3% (95% CI, 0.7-1.9). In multivariate analyses, incident POAG was associated with baseline variables including increased age (OR, 4.3; 95% CI, 1.4-13.8; P = .02; 70 years or older vs 50-59 years), elevated IOP (OR, 3.5; 95% CI, 2.0-5.9; P < .001; per 10 mm Hg increase), lower education level (OR, 0.3; 95% CI, 0.1-0.8; P = .02; post-primary education vs no formal education), and the presence of myopia (OR, 3.4; 95% CI, 1.3-8.6; P < .01). CONCLUSIONS: The average annual incidence of POAG in Bai Chinese was lower than that in populations of African descent and white race. The results are important to elucidate the racial/ethnic difference in POAG incidence and for the clinical management and health resource allocation in China.

Preparation and evaluation of HPMC-based pirfenidone solution in vivo.

CONTEXT: Pirfenidone (PFD) has exhibited therapeutic potential in the treatment of cell proliferative disorders. The previously developed 0.5% water-based PFD eye drops by our team exhibited antiscarring effectiveness and ocular safety but with a limit of short half-life and poor bioavailability. OBJECTIVE: To increase bioavailability of the water-based PFD eye drops, we prepared a viscous solution by adding hydroxypropyl methylcellulose (HPMC, F4M), which acted as a viscosity-enhancer. Subsequently, we compared the HPMC-based PFD solution with the water-based PFD eye drops. MATERIALS AND METHODS: PFD solution with 1% HPMC (w/v) was prepared, and the viscosities at different shear rates were measured to investigate its rheology. PFD concentrations in the tear, aqueous humor, conjunctiva, cornea, and sclerae of New Zealand rabbits were detected at different time points with high-performance liquid chromatography (HPLC) following single instillation of the 0.5% PFD (w/v) water-based eye drops or HPMC-based solution. RESULTS: Compared with the 0.5% water-based PFD eye drops, the HPMC-based solution increased the PFD levels in tears and prolonged the residence time from 10 to more than 20 min (p < .01). Consequently, the concentrations of PFD in aqueous humor, conjunctiva, cornea, and sclera were elevated to varying degrees until 90 min after topical administration. CONCLUSIONS: The developed formulation possesses a same readily administration and simple preparation as the PFD eye drops; however, the HPMC-based solution exhibited the higher bioavailability.

Phakic posterior chamber intraocular lens for unilateral high myopic amblyopia in Chinese pediatric patients.

AIM: To assess the outcomes of posterior chamber implantable collamer lens (ICL) implantation in Chinese pediatric patients with unilateral high myopic amblyopia. METHODS: Eleven eyes of 11 amblyopic patients aged 11.02±3.34y underwent ICL (model V4, Staar Surgical Inc.) implantation to treat unilateral anisometropia were studied. Visual acuity, cycloplegic refraction, contrast sensitivity, stereopsis, intraocular pressure (IOP), vaulting, corneal endothelial cell count and complications were evaluated. Patients completed follow-up at 3d, 1, 3mo and the last follow-up time (mean 8.18±2.82mo) after surgery. RESULTS: The mean myopic anisometropia was -13.70±3.25 D preoperatively and +0.69±2.63 D at 8mo postoperatively. The logMAR corrected distance visual acuity (CDVA) of the amblyopic eye was 1.51±0.72 preoperatively and 0.75±0.40 at 8mo postoperatively. The logMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by a mean of 0.64, 1.55, 1.82 and 2.64 lines and gained more than 2 lines accounted for 18%, 45%, 45%, 64%, respectively. The contrast sensitivity of 0.5, 1 and 2 cpd in amblyopic eyes was significantly increased after surgery. No patient had near stereopsis recovery. The vaulting at 3 and 8mo was significantly lower than that at 1mo postoperatively. No other intraoperative or postoperative complications were observed, except an acute pupillary block glaucoma happened in a patient at two weeks postoperatively. CONCLUSION: This short-term results indicate that ICL implantation can be a promising alternative therapy for high myopic anisometropic amblyopia in pediatric patients who have failed with conventional treatments and not suitable to corneal refraction surgery.

Prevalence, types and awareness of glaucoma in a multi-ethnic population in rural China: the Yunnan Minority Eye Study.

PURPOSE: To determine the prevalence, types and awareness of glaucoma in a rural community in China and to examine possible ethnic variations. METHODS: The Yunnan Minority Eye Study was a multi-ethnic community-based eye survey using random cluster sampling strategies. 2133 Bai, 2205 Han and 2208 Yi Chinese aged 50 years or older participated in this study. Glaucoma including primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG) and secondary glaucoma was defined based on the International Society of Geographical and Epidemiological Ophthalmology criteria. RESULTS: The overall age-standardized prevalence of all glaucoma was 2.6% (95% confidence interval [CI]: 2.2-3.1%) in this population. It was 1.8% (95% CI: 1.1-1.9%) for POAG and 0.5% (95% CI: 0.9-1.6%) for PACG, respectively. Among 29 people with secondary glaucoma, 27 (93%) were blind in at least one eye. The presence of primary open-angle glaucoma was associated with male gender (odds ratio [OR] = 2.94; comparing men with women), Yi ethnicity (OR = 2.27; comparing Yi with Han people), higher IOP (OR = 1.09 per mmHg increase), and the presence of myopia (OR = 1.84). Of the 212 participants with glaucoma, only 38 (18%) were aware of the disease and had been diagnosed previously as having glaucoma or suspected glaucoma. Patients who were better educated tended to be aware of the disease. CONCLUSIONS: Significant ethnic difference in the prevalence of POAG was observed in this study. The low awareness of glaucoma highlights the pressing need to increase public awareness of this potentially blinding condition in rural China.

Intraocular Pressure-Lowering Potential of Subthreshold Selective Laser Trabeculoplasty in Patients with Primary Open-Angle Glaucoma.

Purpose. To compare the efficacy of subthreshold and conventional selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in the patients with primary open-angle glaucoma (POAG). Methods. Fifty-two eyes from fifty-two POAG patients were randomized into two groups, one group treated with subthreshold SLT using two-thirds of the conventional energy and the other one treated with the conventional energy. IOP was measured with the Goldmann tonometer and the anterior chamber inflammation was determined using laser flare meter. Results. The initial energy dosage used in subthreshold SLT group was significantly lower than the amount of the energy used in conventional SLT group (0.4 ± 0.1 mJ versus 0.6 ± 0.1 mJ, P = 0.030). The total energy dosage was also significantly lower in subthreshold SLT group compared to the other group (37.6 ± 3.3 mJ versus 51.8 ± 5.7 mJ, P = 0.036). However, the level of inflammation in aqueous humor, amount of reduction in IOP, and the success rate in controlling IOP was the same in both groups. Conclusion. The efficacy of subthreshold SLT group in reducing IOP in POAG patients is comparable to the efficacy of conventional SLT group.

[Progress of anti-glaucoma fixed combination formulation].

Glaucoma is a common cause of visual impairment and irreversible blindness. Medication is important in the management of glaucoma, especially in primary open-angle glaucoma. Combination drug therapy is needed because single drug therapy can not always control the intraocular pressure effectively to a safe level in glaucoma patients with higher baseline intraocular pressure. Traditional unfixed combination therapy of glaucoma may disturb daily life because the frequency of admitting eye-drops is increased, it is less persistence or compliance, and results in the increase of local concentration of preservatives in the eye. The new fixed combination formulations for glaucoma have been developed to be safer, more effect and more compliable. This article reviews the comparative studies of therapeutic effects of anti-glaucoma fixed combination formulation and summarizes features of each formulation, and then prospects the new developing tendency of anti-glaucoma medication.

[Quality of life in patients with primary congenital glaucoma following antiglaucoma surgical management].

OBJECTIVE: To evaluate the 23-item scale of Quality of Life (QOL) for patients with primary congenital glaucoma (PCG). METHODS: It was a cross-sectional study. The QOL scale specific for patients with PCG was firstly evaluated on 51 patients with PCG following antiglaucoma surgery at last followup visit (7.80 years +/- 2.93 years with a median at 7 years) and 50 participants with normal visual acuity (VA) as control. All participants were aged 5-20 years old. The QOL of PCG was evaluated with type of disease, severity, surgical outcome, postoperative VA, age, gender and personality by using single-factor correlation analysis and multiple-factor stepwise regression analysis. RESULTS: The PCG-QOL scale achieved good reliability, validity and responsibility for PCG and 23-item were all qualified for QOL evaluation of PCG. The total scores of QOL in patients with PCG were significantly lower than those of normal individuals (PCG 60.22 +/- 10.02,normal individuals 71.41 +/- 10.11; t = 5.682, P = 0.000). Single-factor correlation analysis showed that the total scores of QOL were associated significantly with the severity of glaucoma (F = 24.026, P = 0.000), surgical outcome (t = 2.638, P = 0.009) and postoperative VA (F = 11.248, P = 0.000); The visual function scores were associated significantly with the severity (F = 12.677, P = 0.000) and postoperative VA (F = 10.369, P = 0.000). The self-care ability scores were associated significantly with the severity (F = 11.064, P = 0.000) and surgical outcome (t = 2.297, P = 0.042). The social and mental scores were all correlated significantly with the severity (F = 6.869, P = 0.020; F = 5.721, P = 0.019) and personality (t = 4.352, P = 0.009; t = 2.297, P = 0.042). Multiple-factor stepwise regression analysis showed that there were significant correlations between total scores and the severity (P3 = -6.985, P = 0.001), postoperative VA (beta = -4.978, P = 0.003) and personality (13 = -5.201, P = 0.020). CONCLUSIONS: The PCG-QOL scale could be used for evaluating the QOL of PCG patients aged 5-20 years. The main factors that influence on the QOL of patients with PCG are severity of the disease, postoperative VA and personality. Preventing progression of glaucoma, improving VA and giving right psychological guidance may improve the QOL of patients with PCG.

[Clinical observation of trabeculectomy for primary angle closure glaucoma].

OBJECTIVE: To evaluate the effect of trabeculectomy on intraocular pressure (IOP) and complications in eyes with primary angle closure glaucoma (PACG). METHODS: It was retrospective clinical study. PACG was classified as acute primary angle closure glaucoma (APACG) group and chronic primary angle closure glaucoma (CPACG) group. APACG was then divided into acute attack phase and chronic phase, and CPACG was divided into chronic phase and late phase. IOP, best corrected visual acuity were compared before and after trabeculectomy in different subgroup of PACG. In addition, the incidence of complications of trabeculectomy was assessed. Statistical analyses were performed using SPSS 12.0 statistics software. Categorical variables such as best corrected visual acuity were compared using nonparametric test, continuous variables such as age and IOP were compared between the two groups using independent two-sample t-tests. Pre- and postoperative IOP were compared using one-way analysis of variance of repeated measures. RESULTS: 40 eyes (37 cases) of APACG and 56 eyes (45 cases) of CPACG were enrolled in this study. The median follow-up period was 24 and 25 months, respectively. IOP was significantly decreased from (53.6 +/- 17.9) mm Hg (1 mm Hg = 0.133 kPa, preoperation) to (10.5 +/- 4.9) mm Hg (postoperation) at time of discharging from hospital and (14.0 +/- 10.3) mm Hg at time of final follow up in APACG (F = 100.783, P < 0.01), respectively, and from (36.8 +/- 13.8) mm Hg to (11.7 +/- 4.2) mm Hg at time of discharging from hospital and (13.8 +/- 4.5) mm Hg at time of final follow up in CPACG (F = 54.383, P < 0.01), respectively. The IOP remained controlled (< or = 21 mm Hg) without antiglaucomatous medication in 38 eyes (95.0%) of APACG and in 50 eyes (89.3%) of CPACG. Visual acuity was significantly (H = 12.316, P < 0.01) decreased after trabeculectomy in all sub-types of PACG by Kruskal-wallis analysis. Shallow anterior chamber was commonly occurred after trabeculectomy. CONCLUSIONS: Trabeculectomy is an effective method to control IOP in APACG and CPACG. However, the high proportion of impaired vision was found following trabeculectomy in this study and warranted further clinical investigation.

[Preliminary study on normal values of blue-on-yellow perimetry in central thirty degrees].

OBJECTIVE: To investigate the normal values and related factors of blue on yellow perimetry (BYP) in the central 30 degree. METHODS: A cross sectional study design was performed on this study. BYP was performed in a Humphery750II-i perimetry with 30-2 procedure and Fastpac strategy. The study samples consisted of 116 eyes of 58 normal subjects. The visual field indices were calculated and their related factors were analyzed. SPSS 13.0 software package was used for experiment data analysis. Comparison of three blue-on-yellow visual indices, including mean sensitivity (MS), mean defect (MD) and pattern standard deviation (PSD), were investigated by multi-way ANOVA with randomized block design method among four age groups. Relationship between age and visual field index was described and interpreted by calculating Pearson product-moment correlation coefficient and linear regression. Chi-square test was applied to determine the distribution of population and gender among four age groups. Significance level was set to alpha = 0.05. RESULTS: Values of the three different visual indices, MS, MD and pattern PSD, in central 30 degree of BYP were (21.23 +/- 2.96) dB, (-3.94 +/- 2.20) dB and (3.13 +/- 0.72) dB, respectively. The differences of MS, MD and PSD values between right eye and left eye were not statistically significant (F = 0.488, 0.833, and 0.677, with P = 0.487, 0.482 and 0.414, respectively). No differences in these three indices could be detected between male and female (F = 0.149, 0.547 and 1.948, with P = 0.702, 0.463 and 0.169, respectively). Significant difference in three visual field indices was identified among four different age groups (F = 48.160, 54.250 and 9.329, with P = 0.000, 0.000 and 0.032, respectively). The light average sensitivity in four quadrants showed statistically significant difference in all age groups (F value for quadrant factor was 81.544, P = 0.000). The MS value decreased 2.5 dB and the MD value increased -0.932 dB with the 10-year-old increasing. The average sensitivity in different eccentric ranges had a significant statistical difference (F value for eccentricity factor was 48.257, P = 0.000). CONCLUSIONS: The gender and the laterality do not affect the MS, MD and PSD in the BYP of normal subjects. The light average sensitivity is asymmetry in the four different quadrant, decreases in a linear decline with age and declines with the eccentricity.

[Effect of Rosiglitazone on the proliferation and the production of transforming growth factor-beta 1 in cultured human Tenon' s capsule fibroblasts].

OBJECTIVE: To investigate the effect of Rosiglitazone on the proliferation and the production of transforming growth factor-beta 1 (TGF-beta 1) in cultured humans Tenon's capsule fibroblasts (HTFs). METHODS: It was a experimental study. HTFs were cultured and subcultured in vitro. After HTFs were treated with different concentrations of Rosiglitazone, the proliferation was detected by MTT assay. The migration ability was detected by a scratch method. The production of TGF-beta 1 was determined by ELISA. TGF-beta 1 mRNA expression was examined by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Compared with control group, Rosiglitazone significantly (F = 178.293, P < 0.01) inhibited the proliferation (0.33 +/- 0.01 vs 0.29 +/- 0.02) and the migration of HTFs in a dose-dependent manner with the concentrations ranged from 20 to 500 mg/L. Rosiglitazone also significantly (F = 86.404, P < 0.01) reduced the production of TGF-beta 1 in HTFs (323.48 +/- 13.69 vs 267.48 +/- 20.31). TGF-beta 1 mRNA was significantly (F = 176.102, P < 0.01) down-regulated (0.69 +/- 0.02 vs 0.55 +/- 0.02). CONCLUSIONS: This study suggests that the inhibition of the proliferation of Tenon's capsule and the migration of HTFs by Rosiglitazone is due, at least in part, to decrease the production of TGF-beta 1.

[Effect of endocyclophotocoagulation on survival of corneal grafts].

OBJECTIVE: To observe the effect of semiconductor (diode) laser endocyclic-photocoagulation (ECP) on the survival of corneal grafts for patients with uncontrolled refractory glaucoma secondary to penetrating keratoplasty (PKP). METHODS: Thirty-four eyes of 34 patients with refractory glaucoma were prospectively assigned to diode laser ECP in 12 eyes, and diode laser ECP with anterior vitrectomy in 22 eyes in Zhongshan Ophthalmic Center from March 2000 to April 2004 as ECP group. Twenty-six eyes of 26 patients were underwent trans-scleral cyclophotocoagulation (TCP) as TCP group. The preoperative and postoperative follow-up parameters evaluated included visual acuity (VA), intraocular pressure (IOP), corneal graft clearance, endothelial cell density (ECD), anterior chamber inflammation, ciliary processes and chamber angle (viewed under ultrasonic biomicroscope, UBM), and the postoperative complications were recorded as well. RESULTS: In ECP group, a mean of (2.7 +/- 1.3) glaucoma medications was used with mean preoperative IOP value of (40.1 +/- 9.6) mm Hg preoperatively. IOP was decreased (below 21 mm Hg) in 13 eyes (38.2%) 3 months postoperatively. Six months after ECP, decreased IOP (below 21 mm Hg) was obtained in 23 eyes (67.7%). In TCP group, a mean of (2.3 +/- 1.5) glaucoma medications were administrated with mean preoperative IOP value of (41.4 +/- 10.4) mm Hg preoperatively. IOP was decreased (below 21 mm Hg) in 10 eyes (38.5%) 3 months postoperatively. Six months after TCP, decreased IOP (below 21 mm Hg) was obtained in 8 eyes (30.8%). The difference of IOP reduction between these two groups showed no statistical significance 3 months postoperatively (chi(2) = 0.0003, P = 0.986), but it was statistically significant after 6 months (chi(2) = 8.024, P = 0.005). In ECP group, 25 eyes had clear corneal grafts preoperatively, with mean ECD of (1353 +/- 293) cells/mm(2). Postoperative mean ECD was (1013 +/- 170) cells/mm(2). In TCP group, 20 eyes had clear corneal grafts preoperatively, with mean ECD of (1221 +/- 191) cells/mm(2). Postoperative mean ECD was (847 +/- 136) cells/mm(2). The difference of ECD between ECP and TCP group was statistically significant (t = -0.009, P = 0.033). Reactive no-specific inflammation in anterior chamber occurred in 9 eyes (26.5%) in ECP group and 21 eyes (80.8%) in TCP group, which showed statistical significance (chi(2) = 17.376, P = 0.001). CONCLUSIONS: ECP proved more efficacious than TCP in controlling IOP in patients with post-penetrating keratoplasty glaucoma in long-term observation. Compared with TCP, ECP shows less corneal graft endothelial cell loss, and comparatively mild post-ECP uveitis, which improves the survival of corneal grafts greatly.

[The clinical study of endoscopic cyclophotocoagulation on the management of refractory glaucoma].

OBJECTIVE: To evaluate the efficacy and safety of endoscopic cyclophotocoagulation (ECP) in the management of refractory glaucoma. METHODS: ECP procedures were performed on fifty-one eyes of 47 patients with refractory glaucoma by using the Microprobe (Endo Optiks, URAM E2) integrated laser endoscope system. All patients were followed-up from 6 to 16 months (mean 10.8 months), with four eyes receiving a second treatment. The changes of intraocular pressure (IOP), visual acuity and complication were pre- and post-operatively observed. RESULTS: Compared to preoperation, the IOP of postoperation was significantly (P < 0.01) decreased at week 1, 4, 12, and 24 [(35.3 +/- 13.0) mm Hg (1 mm Hg = 0.133 kPa) vs (19.9 +/- 13.2) mm Hg, (22.0 +/- 11.6) mm Hg, (17.6 +/- 11.6) mm Hg, and (17.0 +/- 10.4) mm Hg, x +/- s, respectively]. The mean number of IOP-decreased drugs used was significantly (P < 0.01) reduced from 3.3 to 1.0 of postoperation. 51.0% of all 51 eyes with the postoperative IOP less than 21 mm Hg did not receive any drug, and 25.5% with supplemental drug treatment. The visual acuity was significantly (P < 0.01) improved postoperatively. Postoperative hyphema were found in 4 eyes, fibrous exudates in 23 eyes, and exudative choroids detachment in 2 eyes, all of which occurred at the early postoperative stage and were healed within 2-16 days. No other complications were observed. CONCLUSION: ECP is a safe and effective procedure for the management of refractory glaucoma without serious complications.

[The experimental histopathologic changes of applying perfluoropropane to filtering surgery in rabbits].

OBJECTIVE: To study the histopathologic changes of filtering blebs by subconjunctival application of perfluoropropane (C(3)F(8)) after trabeculectomy in rabbit eyes. METHODS: Twenty rabbits were randomly divided into two groups, each group consisting of 10 rabbits. Trabeculectomy with topical application of C(3)F(8) was performed on one eye and trabeculectomy alone on the other eye in first group. Whereas, trabeculectomy with topical application of mitomycine (MMC) was performed on one eye and trabeculectomy with topical application of C(3)F(8) on the other eye in second group. Histopathologic changes in filter bleb were investigated by immunostaining at 3 days, and at week 1, 2, 3, and 4 after surgery. RESULTS: Fibroblasts: The numbers of fibroblasts in eyes after trabeculectomy with C(3)F(8) gas as well as trabeculectomy with MMC were significantly reduced (P < 0.05) compared to eyes with trabeculectomy alone. There was no significant statistical difference in the numbers of fibroblasts between trabeculectomy with C(3)F(8) gas group and trabeculectomy with MMC group. Newly formed collagen fiber: Immunostaining of collagen fibers showed that the numbers of newly formed collagen fibers in trabeculectomy with C(3)F(8) gas group and trabeculectomy with MMC group were significantly decreased compared to trabeculectomy alone group. However, there was no significant statistical difference between numbers of fibers in trabeculectomy with C(3)F(8) gas group and trabeculectomy with MMC group. Neovascularization and inflammation of filtering blebs: The differences were not statistically significant among trabeculectomy with C(3)F(8) gas, trabeculectomy with MMC group and trabeculectomy alone group. CONCLUSION: Trabeculectomy with subconjunctival retention of C(3)F(8) gas can enhance the success rates of surgery by suppressing the growth of fibroblasts and synthesis of newly formed collagen fibers, and by inhibiting scar formation.